Vermont’s Struggle for Single-Payer Healthcare

March 10, 2011

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After years of political frustration, Earl Mongeon had to see it to believe it. Often, when he finishes his twelve-hour night shift at IBM in Essex Junction, Mongeon heads home for breakfast and a few hours of brush clearing on his sixty-acre lot in Westford. In mid-January, the 55-year-old microprocessor assembler and workers’ rights advocate hopped into his car and drove in the opposite direction, to Montpelier. There, at the state Capitol, Mongeon and other supporters of single-payer healthcare gathered to hear Senators Bernie Sanders and Patrick Leahy, Congressman Peter Welch and new Democratic Governor Peter Shumlin explain that last year’s national healthcare bill—a costly mix of subsidies to private medical plans, some insurance market reforms, Medicaid expansion and a mandate that people buy coverage if they don’t already have it—isn’t good enough for the Green Mountain State. The top state and federal officeholders pledged to work together for something better. “We firmly believe we can be the state that passes the first single-payer system in the country,” Shumlin declared.

Mongeon and other supporters of single-payer have marched and lobbied for years, most recently under the banner of the Vermont Workers’ Center and its “Healthcare Is a Human Right” campaign. Their tireless activism had a lot to do with spurring Vermont’s singular display of independence and political unity. Two weeks earlier, several hundred VWC supporters descended on the legislature on its opening day. State House and Senate leaders, including some recent converts to the single-payer cause, paid fealty to the grassroots movement. Before a boisterous crowd of union members and community activists, 71-year-old Peg Franzen, a VWC leader and disability rights advocate, hailed the “people power” that had persuaded legislators to commission a detailed study of options for universal healthcare last year. In late January a joint session of the Democrat-dominated legislature received a 203-page report from Dr. William Hsiao, the Harvard healthcare economist hired to develop a road map for reform. Hsiao’s research team identified fifteen hurdles to creating the system they recommended: universal coverage with equal access and a common benefit package that includes community-based preventive and primary care, as well as control in the escalation of health costs.

Undaunted by the roadblocks ahead, Shumlin’s special assistant for healthcare, Anya Rader Wallack, went before a joint legislative committee on February 8 to unveil H. 202, “An act relating to a single-payer and unified health system.” Wallack spelled out a three-stage reform process, spanning at least four years but beginning with the creation of a Vermont Health Reform Board to control costs and streamline payment methods. Wallack described Vermont’s current system of multiple private and public payers as “too complex and misguided,” noting that it leaves “more than a quarter of the state’s population potentially facing healthcare bills that send them to bankruptcy.” On behalf of the governor, she insisted that “this craziness must stop. We have to get insurers out of managing medicine and allow providers to use technology and appropriate quality oversight to get waste out of the system.”

The perfect storm for fundamental reform seems to have arrived in America’s second-smallest state, but the wind is blowing rightward elsewhere in the country, with the new Republican majority in the House voting to repeal the Patient Protection and Affordable Care Act, which they brand “Obamacare.” Red-state attorneys general and their GOP governors are challenging the constitutionality of PPACA by focusing on its controversial individual mandate. Healthcare reformers in Vermont aren’t happy with President Obama’s scheme either. That’s why they’re trying to create a social insurance system that would sever the connection between coverage and employment and make access to medical care a “human right” for the state’s more than 625,000 citizens. Marketplace competition and profiteering—given a renewed lease on life nationally by PPACA—would be phased out locally as soon as possible. If single-payer works in Vermont, its backers envision the state becoming the Saskatchewan of America, just as Canada’s thinly populated but left-led prairie province paved the way for Medicare-for-all north of our border fifty years ago.

Getting from here to there will not be easy. The Green Mountain State’s single-payer initiative could be delayed unnecessarily by the implementation timeline of PPACA. Under that law, every state must have health insurance exchanges in order to get the hundreds of millions in new federal dollars to subsidize private benefits. Unless PPACA is amended—as President Obama recommended on February 28—any pilot projects headed in a single-payer direction would be delayed until 2017. In the now GOP-dominated House, Representative Welch has introduced a bill authorizing the federal waivers needed for Vermont to become “a laboratory for innovation and excellence” in three years, rather than six. As the New York Times reported on March 1, Welch’s bill has “no Republican co-sponsors, making its prospects for passage uncertain at best.”

Single-payer also faces resistance from big business, inside and outside the state. (A taste of that was provided six years ago by antiunion IBM, which held in-plant meetings for 6,000 workers to warn them that a single-payer bill, then pending before the legislature, would require $1 billion in new taxes and force businesses to leave.) A former state legislator from Putney, Governor Shumlin is also part owner of a family business that made him a multi-millionaire. In the face of blunt opposition from his fellow employers, he has pitched single-payer as a way to make Vermont more “business friendly” by curbing healthcare costs, which have doubled in the past decade. Many of the entrepreneurs affiliated with Vermont Businesses for Social Responsibility do seem to favor decoupling health insurance from employment, although not necessarily via a single-payer system. The more mainstream and politically influential Associated Industries of Vermont displays little enthusiasm for moving to a publicly funded plan financed by payroll taxes.

Speaking at a union conference in Burlington over Martin Luther King Day weekend, Mark Dudzic of the Washington, DC–based Labor Campaign for Single Payer Health Care warned about a deluge of anti-single-payer propaganda. “There will be a massive mobilization of corporate power to smash any state single-payer initiative,” he predicted. “Vermont is going to be one of the first battlefields in that fight.” In unionized workplaces—including those represented by the state’s two largest unions, the Vermont Education Association (VEA) and the Vermont State Employees Association (VSEA)—some single-payer advocates worry not enough is being done to educate and mobilize members, whose own negotiated medical benefits are currently at risk. In Vermont, as in other states, there’s growing taxpayer resentment at paying for coverage that most private-sector workers don’t have anymore, whether unionized or not.

At every teachers union bargaining table in Vermont, management is seeking bigger premium contributions, part of a larger giveback trend that has triggered several strike threats. No group of union members has a bigger stake in building a viable tax-supported system of universal coverage than public employees—because their healthcare is already publicly funded by state, county or municipal governments. Nevertheless, as VWC activist and VSEA member Leslie Matthews notes, her own union has not been leading the struggle because some workers are “apprehensive that healthcare reform could lead to erosion of hard-won benefits.” In reality, Matthews argues, “it’s the rising costs, increasing inequities and cost shifts in our current healthcare system that will ultimately bring us down. As union members, our access to affordable healthcare will only be secure when all working people have access to affordable healthcare.”

Workers’ Center director and lead organizer James Haslam does report that the American Federation of Teachers, the Communications Workers of America and the AFL-CIO have all increased their funding of VWC activity. Other national groups, like the Universal Health Care Action Network, have created a “Help Vermont Win! Campaign Fund” to channel more resources into the fight. In late March Physicians for a National Health Program will send nursing and medical students to Vermont to rally support for single-payer. And on May 1 the Jobs with Justice–affiliated VWC will sponsor its biggest May Day “March on Montpelier” ever—to adopt the strongest possible version of Shumlin’s plan.

The new governor’s commitment to the cause is a case study in how Democrats could behave elsewhere—on healthcare and other issues—if their party faced more challenges from the left. Before his run last fall, Shumlin’s only previous bid for statewide office was a failed campaign for lieutenant governor in 2002. His candidacy, as a Democrat, was undermined when 25 percent of the electorate backed Anthony Pollina, a Progressive Party member and longtime single-payer backer who now serves in the State Senate. In last year’s crowded Democratic gubernatorial primary, all the candidates played a game of healthcare reform one-upmanship that helped solidify support for single-payer. Shumlin won the free-for-all by just over 200 votes, even though he was not the preferred nominee of the VEA, VSEA or state AFL-CIO.

In the general election, Shumlin’s opponent was Brian Dubie, an affable Republican who garnered some labor support based on his membership in the Air Line Pilots Association. In the last month of the campaign, the race was very close. That’s when the state’s big-foot independent socialist stepped into the ring. Rallying his own grassroots base, Bernie Sanders held a series of GOTV events for Shumlin that helped the Democratic candidate gain favor among working-class Vermonters who might otherwise have drifted toward Dubie. Shumlin ended up winning by less than 2 percent of the vote.

At a Nation book-signing event in Boston in February, Shumlin’s white-haired, 69-year-old helper was welcomed by local activists. In his discussion with them, Sanders noted that single-payer has become “absolutely mainstream” in Vermont because “we’ve been talking about the issue for thirty years.” But he warned that further grassroots organizing was needed because “this is by no means a done deal.” Back home, the Vermont Workers’ Center and allied groups are taking nothing for granted either, as they gear up for a spring offensive in Montpelier to keep single-payer from getting bogged down in the public policy equivalent of Vermont’s fabled “mud season,” which has never been kind to new models seeking traction, much less the fast track.

Steve EarlySteve Early is the author, most recently, of The Civil Wars in U.S. Labor (Haymarket). Early spent many years helping members of the Communications Workers of America bargain about health insurance issues. He moved to Richmond two years ago and is writing a book about the city. He belongs to the Richmond Progressive Alliance.